questions (please answer in docs, not ppt):1.

The physical examination of skin

and mucous membrane in case of IDA. In point!

2. Mechanism of absorbtion of Heme Iron and Non-heme Iron in children. In

details!

3. Why premature and LBW baby more frequently suffers from IDA? The
mechanism!

4. What does it mean: Iron binding capacity? How do you check this in details?

5. Which side effects after using Fe-contained medicines do you know? The
molecular mechanism?

1. 1: The physical examination of skin and mucous membrane in case of IDA. In

point!

Pallor of skin and mucus membrane

Pale nail beds with brittle nails,nails thin and flat

Palmar creases of hand

Dry skin

Blue sclera

Angular stomatitis soreness at mouth angle

Atrophic glossitis smooth tongue

Kilonychia spoon shaped nails

2. 2:Mechanism of absorbtion of Heme Iron and Non-heme Iron in children. In

details

HEME IRON:

Food sources that contain hemoglobin also contain heme iron: pork, red meat,
fish & poultry.
Heme iron is absorbed better than non-heme iron, and its absorption is not affected
by other things you eat. You absorb 15-35% of the heme iron you eat!

NON HEME IRON:

All non-meat based iron is non-heme iron. Non-heme iron is not absorbed by
the body as well as heme iron. Only 2-20% of non-heme iron is absorbed.

HEME IRON ABSORBTION

10% of dietary iron is absorbed

Absorption depends on:

-dietary iron content

- bioavailability (heme vs. non- heme)

- mucosal cell receptor number

Main absorption occurs in duodenum

Heme (meat) >> non-heme iron sources

-(30%-50% vs. <10%)

-Ferrous sulfate >> ferric sulfate

-Enhanced by red meat, ascorbic acid, breast milk

-Diminished by vegetable fiber, cow milk, egg yolk, tea, phytates, phosphates
(soda)

Iron is converted from Fe3+ to Fe2+ by ferrireductase

Fe2+ transported across mucosal surface of enterocyte by DMT1

(divalent metal transporter 1), stored as ferritin

Ferritin releases Fe2+ which is transported across basolateral surface of

enterocyte with help of ferroportin

Fe2+ converted back to Fe3+ by Hephaestin

Fe3+ binds to transferrin in plasma

Iron uptake by the erythroblast

Fe3+ bound to transferin attaches to transferin receptor on erythroblast

Transferin and Fe3+ separate, Fe3+ combines with heme to make hemoglobin
 Extra Fe stored as ferritin

Apotransferrin exported out of erythoblast

Iron absorbtion is regulated by:

Dietary regulator:

a short-term increase in dietary iron is not avidly absorbed, as the mucosal

cells have accumulated iron and "block" additional uptake.

Stores regulator:

as iron stores increase in the liver, the hepatic peptide hepcidin is

released that diminishes intestinal mucosal iron ferroportin release and the
enterocytes retain any absorbed iron and are sloughed off in a few days; as body
iron stores fall, hepcidin diminishes and the intestinal mucosa is signaled to release
their absorbed iron into circulation.
3: Premature infants. Babies who are born prematurely may have low levels of
stored iron. This is because the majority of a baby's iron stores are built up in the
later stages of pregnancy.

women need approximately 50% more iron during pregnancy; increasing from 18 to
27 milligrams (mg) per day.1 A mother and baby need more iron for a few different
reasons. As the mothers body grows, the amount of blood in her body also grows,
especially in the last three months of pregnancy. During this time she have as
much as 50% more blood in her body. To produce more red blood cells, the mothers
body need additional iron to make hemoglobin, the part of the red blood cell that
carries oxygen. Also, the growing baby takes all the iron it needs from mom,
regardless of how much she has available in her system. Towards the end of
pregnancy the baby will be storing iron for his or her first six months of life. Because
of these changes and other changes like these, some women may develop anemia
during their pregnancy
The first years of an infant's life are filled with tremendous growth and
development. baby will change more during his or her first two years than at any
other time. Because of this amazing growth, children less than two years old,
particularly those aged 9-18 months, are at the highest risk of any age group for
developing iron deficiency anemia.1 Therefore, during this critical time it is very
important for your baby to get enough calories and nutrients, including iron.

Infants and toddlers 6-24 months of age need a lot of iron to grow and develop. The
iron that full-term infants have stored in their bodies from their mothers is used up
in the first 4-6 months of life. After that, infants need to get iron from food or
supplements. Because of this, iron deficiency anemia does not usually develop until
the baby is about 9 months old. Premature and low-birth-weight babies are at even
greater risk for iron deficiency anemia because they dont have as much iron stored
in their bodies

What does it mean: Iron binding capacity? How do you check this in details?

Ans : Total iron binding capacity (TIBC) is a blood test that measures iron levels in
the blood. The test helps measure the ability of a protein called transferrin to carry
iron in the blood.

How much iron is binding to this protein is a proxy for how much iron is in your
blood at a given time. Too little or too much iron can indicate a number of medical
conditions.

The TIBC test consists of a simple blood test, where blood is drawn from a vein on
the inside of the elbow.

samples were kept refrigerated for no longer than 12 h at 24 C.

NORMAL FINDINGS

Iron

Newborn: 100-250 mcg/dL

Child: 50-120 mcg/dL

TIBC

250-460 mcg/dL or 45-82 micromole/L (SI units)

Transferrin
Newborn: 130-275 mg/dL

Child: 203-360 mg/dL

Transferrin Saturation

Males: 20% to 50%

Females: 15% to 50%

Ranges for normal findings may vary among different laboratories and hospitals. You
should always check with your doctor after having lab work or other tests done to
discuss the meaning of your test results and whether your values are considered
within normal limits.

5: side effects of iron supplement abdominal (tummy) pain constipation or diarrhoea

heartburn feeling sick black stools (faeces)

These side effects should settle down over time, although your we may advise
taking the tablets with food or shortly after eating to help minimise side effects, if
they are severe. we may also recommend you only take one or two tablets a day,
instead of three, if you are finding side effects difficult to cope with. If you cannot
take ferrous sulphate because you get severe side effects, you may be prescribed a
different iron supplement called ferrous gluconate. This supplement should cause
fewer side effects, as it contains a less concentrated dose of iron. However, it may
take longer for iron levels in your body to be restored. In a few cases for example,
if you have chronic kidney disease (CKD) iron injections may be recommended
instead of tablets.

iron pills, we should make sure to take them on an empty stomach, and not with
food for 1/2 hour at least. The iron is better absorbed on an empty stomach.
However, if you cannot tolerate the iron, and our stomach becomes upset, we may
take the iron with food. It is better to take the iron with food, than not to take it at
all. If our body is unable to absorb iron in your stomach, due to celiac sprue,
stomach surgery, or other stomach problems, your healthcare provider may order
intravenous (IV) iron infusions. If your iron deficiency anemia is due to rectal
bleeding, caused by hemorrhoids, or some other bowel abnormalities, it is important
to increase the amount of bulk fiber in your diet per day.

venofer (iron sucrose ) side effects chest pain; feeling like you might pass out;
swelling in your hands, ankles, or feet; trouble breathing; or dangerously high blood
pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion,
chest pain, shortness of breath, uneven heartbeats, seizure). Less serious Venofer
side effects may include:
muscle cramps; weakness, tired feeling; dizziness, anxiety, headache; nausea,
vomiting, stomach pain; diarrhea, constipation; ear pain; sore throat, sinus pain or
congestion; decreased sense of taste; joint pain; or pain, swelling, burning, or
irritation around the IV needle.